Nursing Essays – Nurse Patient Safety

Nurse Patient SafetyThe ICU Nurse and Patient Safety

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Nurses play a central role in direct patient care and safety surveillance at the point of care. This role suggests a need for consensus on a core set of measures that can be used to monitor safe practices and guide resource allocation decisions that affect patient outcomes in a health system.

This work will review factors affecting patient safety in ICU and what to do to reach a proper patient outcome.


Patients in Intensive Care Units are at risk of unsafe care because of the complex environment, also a patient may sustain an injury as a direct result of daily care. This makes nurses uniquely poised to have a tremendous impact on patient safety as professional caregivers in direct contact with patients and their families. Quality care and patient safety require a focused commitment from all level of an organization, yet nurses serve as the bedside safety advocate with the opportunity to put theory into practice. The challenges are: What is the right thing to do? Is the right thing being done? Is it being done right?

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Factors that play a role in patient safety in ICU environment

The critical care setting is one of the most complex environments in a health care facility. Critical care units must manage the intersecting challenges of maintaining a high-tech environment and ensuring staff competency in operating the equipments, providing high-quality care to the sickest patients of a health facility and attending to the needs of staff members working in a very stressful environment (Chang et al, 2005).

Before building initiatives to enhance patient safety, the extent of patient injuries and events in ICUs must be well explained. Critically ill patients are at high risk for complications due to the severity of their medical conditions, the complex and invasive nature if intensive care treatments and procedures and the use of drugs and technology that carry risks as well as benefits (Chang et al, 2005).

What to do?

The first step of patient safety improvement process is to gain the support and engaging leadership.Risk managers, patient safety officers and critical care physicians start working together to make a business case to executives for patient safety investments. In short; implementing ICU patient safety plane becomes a team effort (Rainey and Combs, 2003).

An improvement initiative will be more successful if a culture of patient safety prevails. This should create an ICU environment in which all members of ICU team understand how to exchange patient information in a meaningful and respectful way. A starting point in creating such a culture is to conduct an assessment of the current climate in the ICU whether and how it affects patient care (Rainey and Combs, 2003).

A facility’s approach to provide safe critical care services will depend mainly on the ICU is organized, staffed and designed i.e. ICU staffing, structure and work environment. Generally, there are three organizational models for ICUs; the open model which allows different members of the medical staff to mange patients in the ICU. The closed model is limited to ICU certified physicians managing all cases. The hybrid model, it combines aspects of the previous two models on referral basis (Chang et al 2005, Rainey and Combs 2003 and Pronovost et al 2003).

Work environment within the ICU is characterized by being high work load and fatigue; both have been identified as major negative contributors to patient safety. Staffing an adequate number of critical care educated nurses is essential to the delivery of high quality ICU care (Chang et al 2006).

ICU equipment, technology and systems should be assessed from the perspective of patient safety before acquisition and implementation. When devices do not undergo a rigorous evaluation for appropriateness during acquisition or when they are not used properly or badly maintained, they can contribute seriously to patient safety (Pronovost et al 2003).

Quality indicators: Savitz, Cheryl and Shulamit, conducted a meta-analysis on quality indicators sensitive to nurse staffing in acute care settings and their results did not to specific indicators that should necessarily be examined in monitoring performance and examining trends in safety as related to nursing staff.

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What is needed?

The shortage of critical care nurses has increased concerns for patient safety. Programs must retain experienced critical care nurses and maintain nursing staff competency with medial equipments and procedures. Continuing education must not be neglected on the assumption that the nurse can not be spared (Trossman 2000). Closer cooperation and understanding is always needed for the ICU staff members. Having a clear program for ICU patient safety should make the job easier.


Recognizing the critical linkage between nursing workforce and safe and effective outcome for patients, both health provider and professional organizations are committed to work together to accelerate the adoption of evidence based practices known to improve the working nursing environment, patient safety and quality outcomes for patients.

This necessitates having a culture that supports patients safety, operating the ICUs as a dedicated team managed by intensive care specialists with specialized training. Finally, to ensure that the work environments can support the caregivers to interact productively, make proper level titrated vital decisions, perform medical intervention and operate medical equipments safely.


Chang, S. Multz, A. and Hall, J. (2005). Critical care organization. Critical care clinics, 21(5), 43-53.

Rainey, G. and Combs, A. (2003). Making the business case for the intensivist directed multidisciplinary team model: In Proceedings from the Society of Critical Care Medicine Summit on ICU Quality and Cost. Chicago, IL.

Pronovost, P, Angus, D. Dorman, T. et al. (2003). Physician staffing pattern and clinical outcomes in critically ill patients: A systematic review. JAMA 288(17), 2151-2162

Savitz, L. Cheryl, B. and Shulamit, B. Quality indicators sensitive to nurse staffing in acute care settings. Advances in patient safety, 4, 375-85. Retrieved from on 24/12/2007.

Trossman, S. (2000), Nurses fight short staffing on several major fronts. Am Nurse 32, 1-2.

American Psychological Association (2001). Publication manual of the American Psychological Association (5th ed.). Washington, DC: American Psychological Association.